Treatment Approaches and Recidivism in Sex Offenders

Introduction

The incidence of sex offenders in society is one of the most disturbing of societal ills, and the recidivism of sexual offenders represents a significant social problem. By investigating the contributing factors of sexual offending and the treatment programs currently in use, policy implications can be derived with the goal of improving recidivism rates.

This paper reviews qualitative and quasi-experimental research concerning treatment for sex offenders. This review reflects an understanding that further investigation into the research literature is needed to provide a more comprehensive picture of the effectiveness of treatment interventions. According to Dobash and Dobash (2000), the use of qualitative research is especially effective in providing a basis for realistic future evaluation.

Theoretical Background

To fully understand effective treatment, one must also understand the motivations behind sexual offending behavior. As Calley (2007) notes, "the etiology of sexual offending behaviors is extremely complex and has been linked to mental health issues and family dysfunction," as well as drug abuse.

Mental health problems have been shown to be a significant factor specifically among child molesters, with 46.3% of those surveyed indicating some type of mental health problem ("Summary of sex offender characteristics," n.d.).

Substance abuse is another significant contributing factor. In one study, a group of sexual and non-sexual offenders were compared, and it was determined that there was a higher incidence of substance abuse among those who had committed sexual offenses. As part of a follow-up, Abracen, Looman, DiFazio, Kelly, and Stirpe (2006) note that sexual offenders who received both sex offender treatment and substance abuse treatment reported generally lower levels of recidivism.

In juvenile sexual offenders, substance abuse is a particularly significant contributing factor; it is estimated that 50% of juvenile offenders have a substance abuse history. In addition, there is a demonstrated trajectory of delinquency for these juveniles. According to Calley (2007), sexually offensive behavior is not typically the beginning of the delinquent path — rather, it follows a history of nonsexual delinquent acts. In one survey of 80 juvenile sex offenders, a majority had committed a nonsexual assault prior to the sexual offense, while only 7% had perpetrated a sexual offense alone.

There is also a significant occurrence of nonsexual criminal behavior even after the completion of sex offender treatment for juvenile offenders. According to a literature review by Righthand and Welch, recidivism rates of juvenile sex offenders for nonsexual crimes ranged between 16% and 54% — dramatically higher than sexual recidivism rates, which ranged between 8% and 14% (cited in Calley, 2007).

Organic Approaches to Treatment

To be effective, treatment must take this theoretical knowledge into account. Treatment should focus on the intersection of sexually offending behaviors and their associated factors. This is true for both adult and juvenile offenders.

Greenfield (2006) investigates the organic approach to treatment of sex offenders. He notes that "in order to carry out and be considered responsible for an act in society, which turns out to be unacceptable (actus reus), the 'actor' must have conscious intent (mens rea) to carry out that act." This is the foundation of law and of forensic mental health sciences in the United States. Greenfield compares sex offenders with those who have difficulty dieting, noting that just as eating is a powerful and basic biological drive, so too are the socially unacceptable urges and cravings experienced by sex offenders. As such, Greenfield suggests that the most effective method of treatment is organic.

One of the oldest, and arguably the most effective, approaches to controlling these socially unacceptable behaviors in men — and thereby reducing recidivism rates — is surgical castration. The procedure involves the surgical removal of the testes from the male offender, otherwise known as bilateral scrotal orchiectomy. This procedure has been shown to produce very low recidivism rates of 2% to 4%. Other surgical procedures, including stereotactic neurosurgery and estrogen implants, have also shown very low recidivism rates of less than 5% when used in Europe. However, these treatments are not foolproof methods of eliminating sexually abhorrent behavior, and they come with side effects including somatic complaints, depression, mood swings, and suicidal tendencies (Greenfield, 2006).

There are three categories of pharmacotherapy for sex offenders: antiandrogenic agents, psychotropic agents, and the experimental use of antiepileptic drugs. In the category of antiandrogenic hormonal agents, there are both indirect-acting and direct-acting drugs, based on their effect on male androgenic-hormone production. Psychotropic agents can be divided into medications that treat male hypersexuality — most often using libido-reducing drugs — and those that treat comorbid or co-occurring psychiatric conditions. The third category, the experimental use of antiepileptic drugs, has been widely employed in psychiatric practice as mood stabilizers. Although not as permanent as surgical alteration, pharmacotherapy is not as effective. In addition, the various drugs carry many side effects, ranging from feminization to hepatotoxicity (Greenfield, 2006).